Intracranial hemorrhage in alloimmune thrombocytopenia: stratified management to prevent recurrence in the subsequent affected fetus

Am J Obstet Gynecol. 2010 Aug;203(2):135.e1-14. doi: 10.1016/j.ajog.2010.03.011. Epub 2010 May 21.

Abstract

Objective: We sought to prevent intracranial hemorrhage (ICH) through antenatal management of alloimmune thrombocytopenia.

Study design: A total of 33 women (37 pregnancies) with alloimmune thrombocytopenia and ICH in a previous child were stratified according to the timing of the previous child's ICH: extremely high risk (HR) (n = 8) had ICH <28 weeks, very HR (n = 17) between 28-36 weeks, and HR (n = 12) in the perinatal period. Treatment was initiated at 12 weeks with intravenous immunoglobulin 1 or 2 g/kg/wk, and if the fetal platelet count by cordocentesis was <30,000/mL despite treatment, prednisone and/or more intravenous immunoglobulin were added.

Results: Five of 37 fetuses suffered ICHs. Two ICHs had platelet counts >100,000/mL, and 1 was grade I. The other 2 ICHs were unequivocal treatment failures; both were grade III-IV and resulted in fetal demise.

Conclusion: These findings demonstrate the success of stratified treatment in these HR patients, which tailored interventions according to the timing of the sibling's ICH.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antigens, Human Platelet / immunology
  • Cohort Studies
  • Cordocentesis
  • Female
  • Fetal Blood / cytology
  • Fetal Death
  • Fetal Diseases / blood*
  • Fetal Diseases / diagnostic imaging
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Intracranial Hemorrhages / prevention & control*
  • Maternal-Fetal Exchange
  • Pregnancy
  • Prenatal Diagnosis*
  • Retrospective Studies
  • Secondary Prevention
  • Severity of Illness Index
  • Thrombocytopenia, Neonatal Alloimmune / diagnosis
  • Thrombocytopenia, Neonatal Alloimmune / drug therapy*
  • Treatment Outcome
  • Ultrasonography

Substances

  • Antigens, Human Platelet
  • ITGB3 protein, human
  • Immunoglobulins, Intravenous